As reported in previous articles in this series, a survey of over 1000 patients with FMS and CFS showed that prior to their illness fewer than 1% had disturbed sleep, whereas during their illness this rose to over 90 %.1

Sleep disturbance is a key feature of both CFS(ME) and FMS with hormonal influences which have wide repercussions. Consultant psychiatrist Dr Peter White, of London’s St Bartholomews’s Hospital, states "We know that two thirds of CFS patients have sleep disorders".2

Is This Sleep Disturbance Due to Disturbed Emotions?
A pioneer FMS researcher Dr. Muhammad Yunus has looked at the link between anxiety, stress and sleep disorders and found that while they influence the degree of this symptom they are not the cause in people with FMS (about 20 to 30% of whom he believes do have anxiety/stress influences in their conditions).3

Dr.Yunus has stated, "The central features of FMS are independent of the psychological status and are more likely related to (i.e.resulting from) the FMS itself, although pain severity may be influenced by psychological factors".

He does not however believe that psychological factors should be ignored in people with FMS because they can be aggravating factors where pain is concerned, precisely as they can in any other painful condition such as rheumatoid arthritis or some forms of cancer. In an attempt to get the focus of physicians corrected Dr.Yunus speaks of the ‘disturbed physician syndrome’ (DPS).

He says, "DPS (that is doctors treating people with FMS) people are troubled because of their preoccupation that FMS patients are psychologically disturbed. It is not the FMS patients who are disturbed it is the physicians who are psychologically disturbed because they ignore the data and whatever data there is they manipulate to say what they want."

Anxiety can stem from being permanently in pain, chronically tired and with a list of associated symptoms. It can also act as an aggravating factor and therefore deserves consideration in any treatment plan.

Sleep Problems
What has emerged from research into people affected by FMS is that their muscular aches and pains are frequently the result of the same processes which disturb their sleep, that biochemical imbalances related to poor sleep help to create muscular symptoms, so that the poorer the sleep the more pain and fatigue. Whatever disturbs the sleep causes a chain reaction of other problems and is usually unrelated to the person’s psychological status.

Understanding the Sleep Process
In normal sleep we pass, every 90 minutes or so, through alpha brain-wave patterns (stage 1 light sleep) through progressively deeper stages (stage 2,3,4 or beta, gamma, delta - the deepest stage of sleep). These last three stages are also known as non-REM sleep since the rapid eye movement (REM) which occurs during dreaming is absent in them.

Sleep laboratories have found that nearly half of all people with fibromyalgia have disturbed (by intrusive alpha wave periods) delta stages, and wake up feeling as, or more, tired than when they went to bed.

Many of the remainder of FMS patients suffer from other forms of sleep disturbance (see below).

The Growth Hormone Connection
Delta stage sleep is when growth hormone is released by the pituitary gland, as well as immune system repair functions being more active.

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